A slide showing an X-ray of a surgical instrument inadvertently left in a patients abdomen after an operation brought a collective groan to the audience. Gallagher explained the importance of conducting disclosures openly and honestly, of helping patient’s and their families to understand the repercussions of errors, and of discussing how similar errors will be prevented in the future.
“I have a lot of experience talking with patients about what has gone wrong,” said Gallagher, “and better interprofessional education about how to do this holds the key to better patient communication.”
That’s exactly what the All Health Professions Error Disclosure Day was designed to do. Originally developed by an interprofessional group of faculty members funded by grants from the Josiah Macy Jr. and Hearst Foundations, the training brings together students from across the health sciences schools to practice disclosing errors as healthcare teams to patients and their families. When Brenda Zierler, professor of biobehavioral nursing and health systems in the UW School of Nursing, and Brian Ross, professor of anesthesiology, in the UW School of Medicine received the grants in 2008, opportunities were few for interactive, interprofessional learning for health sciences students.
Zierler, Ross and their team wanted to change that. Sarah Shannon, associate professor of biobehavioral nursing and health systems in the UW School of Nursing and Karen McDonough, associate professor of medicine, Division of General Internal Medicine, at the UW School of Medicine collaborated with others on the Josiah Macy Jr. grant team to develop interactive training for health sciences students. Error disclosure was chosen as a topic for learning team communication skills.
“The All Professions Error Disclosure Day has been a huge success,” said Zierler. “Staff and faculty work hard for many months scheduling this large event. The students enjoy the chance to work together as a team. They are inspirational to observe.”
The room buzzed with conversation when Gallagher asked participants to turn to the classmate next to them and pretend to disclose that they had just spilled their latte on the classmate’s laptop. Students found the conversation difficult and were sometimes surprised by the reactions, which ranged from anger to requests for financial compensation for the damage.
“Learning to disclose errors as a team is a terrific way to learn how to work together effectively,” said Shannon. “Errors raise the ante for the healthcare team by bringing up reactions of guilt and blame, grief and anger among the team members, as well as between the team and the patient and family. Acquiring the skills to approach error disclosure effectively can carry over to other team communication. We make errors as a team; we need to disclosure errors as a team.”
After Gallagher’s presentation, students headed to breakout groups of 10 to 12 medical, pharmacy and nursing students. A faculty member greeted each group and explained they would have a chance to disclose an error. The students were given the case of an elderly patient whose healthcare team missed his allergy alert and gave him an antibiotic that caused a bad reaction. Luckily, the patient was recovering from the mistake. The small groups discussed the error, then divided into three interprofessional teams to plan how to disclose it to the patient’s family member, who was played by another faculty member waiting outside of the classroom.
In one of the classrooms, School of Nursing lecturer Anne Kalkbrenner played the role of the patients daughter. She reacted to the situation with a variety of emotions, from upset and unresponsive, to angry and frustrated.
In one scenario, the daughter entered the room demanding immediate answers from the patient-care team.
“I felt put on the spot,” said one medical student, who agreed to be the first to talk with the daughter. With little time to respond, the student recalled that the group didn’t incorporate the rest of the patient care team into the initial conversation.
The team eventually was able to help the daughter understand her father’s condition and how the error arose. They then told her how they would prevent such an error from happening again.
“It was interesting to see her reaction to us,” said another student at the end of the interaction. “We didnt know what to expect when she walked in.”
Lisa Erlanger, a family physician at Hall Health who led the breakout group, said that interprofessional education is a new and necessary way of training health sciences students.
“When I went to medical school, we didnt have any training like this,” she said. “I think this is a great chance for students to learn how to work together, because this is how we work together at the bedside.”
Error disclosure training isnt just for students. New funding this year allowed for faculty from health sciences schools across the United States to come to the UW to learn how to implement interprofessional education, such as error disclosure training, at their own institution. More than 35 faculty members spent four days at the UW and at the Institute for Simulation and Interprofessional Studies at Harborview Medical Center. There they explored ways to teach their faculty colleagues to be facilitators of interprofessional education and practice.
Leslie Hall, senior associate dean for clinical affairs at the University of Missouri-Columbia and UW’s Brenda Zierler were awarded a second Josiah Macy Jr. Foundation grant to train faculty to lead interprofessional education and practice. Twenty-two faculty members from the Universities of Virginia, North Dakota, Kentucky, Missouri School of Medicine, University of Missouri-Kansas City, Indiana University School of Medicine, Columbia University School of Nursing, and the Medical School of South Carolina joined five UW faculty members from the Veterans Affairs Puget Sound Health Care System and eight UW Health Sciences faculty members for the training last week.
“There is a national focus on training students to work together collaboratively to improve communication, but the training needs to start with faculty first,” said Zierler. “Faculty can model teamwork behaviors for students and they can create the opportunities to train health professional students together by emphasizing communication, teamwork, collaborative care, values and ethics, and role clarity.”